HIQA advises NSAC on international ethics frameworks used to guide policy-making on screening

Date of publication:

HIQA has published a review of international ethics frameworks to help inform the work of the National Screening Advisory Committee (NSAC). NSAC is developing an ethics framework to support its evaluations and deliberations in relation to population-based screening programmes in Ireland. The development of this framework follows the recommendations of the Scoping Inquiry into the CervicalCheck Screening Programme by Dr Gabriel Scally ('the Scally Report'), which emphasised the role of ethics in the consideration of programmes.

HIQA’s review identified and described ethics frameworks used internationally for policy-making in the context of screening. Sources for the review included bodies with responsibility for screening policy-making, public health agencies, national ethics bodies, and international agencies. While considerable variation was found in the content and structure of the frameworks identified, consistencies were noted in the ethical principles and procedural values that are considered. Several frameworks highlighted the need to consider the relevance and relative importance of values or principles within different contexts of screening (for example, adult versus child programmes), and the possibility that some values and principles may conflict with each other. Furthermore, as public health decisions related to screening are taken at the population or community level, the values and principles that guide these decisions differ from those that guide traditional clinical decision-making. Therefore, it is important to balance the consideration of the benefits and harms of screening as they relate to the overall population and for the individual.  

Dr Maírín Ryan, HIQA’s Deputy CEO said: “We found a lot of variability in the frameworks and aspects of ethics that were identified as important internationally. This is most likely due to the different perspectives and value systems that influence how policy-makers explore ethics within decision-making. We advised NSAC that when developing an ethics framework for Ireland, careful consideration should be given to the values and perspectives of the Irish healthcare system.”
You can read the report from the link at the top of the page

For further information please contact:
Marty Whelan, Head of Communications and Stakeholder Engagement
01 814 7480 / 085 805 5202 / mwhelan@hiqa.ie

Notes to the Editor:

  • This review of international ethics frameworks for policy-making in the context of screening was requested by the National Screening Advisory Committee (NSAC). 
  • NSAC was established in 2019 by the Minister for Health as an independent advisory committee to play a significant strategic role in the development and consideration of population-based screening programmes in Ireland.
  • At the request of the Department of Health, the Health Technology Assessment (HTA) directorate within the Health Information and Quality Authority (HIQA) undertakes evidence synthesis and provides evidence-based advice to NSAC on behalf of the Minister for Health.  
  • Based on the findings of this review, a number of important items were identified that should be considered in the development of an ethics framework. These included the: 
    • justification for the approach underpinning the ethics framework
    • use of public health ethics as opposed to ethics used in traditional clinical decision-making
    • rationale for the selection and inclusion of values and principles within the framework
    • specification and tailoring of values and principles to individual contexts in which the framework may be used
    • handling of conflicts between values and principles 
    • intended usage of the framework and the need for the framework to be suitable for use in both general and specific contexts 
    • structuring of decision-making processes to ensure that they are publicly defensible and justifiable.